Transobturator Tape (TOT) Procedure: A Step-by-Step Surgical Video

B F Berk, H A Durak, A E Eren

Transobturator tape; TOT; stress urinary incontinence; midurethral sling; surgical technique

This surgical video demonstrates a step-by-step transobturator tape (TOT) procedure for the treatment of female stress urinary incontinence. The procedure is performed with the patient in the lithotomy position. Following appropriate surgical preparation, a midline vaginal incision is made below the external urethral meatus, and bilateral paraurethral dissection is carefully performed toward the obturator foramen. Small skin incisions are created bilaterally at the level of the obturator foramina. The transobturator needles are then advanced through the obturator pathway under controlled guidance and delivered through the previously prepared vaginal dissection plane. The synthetic midurethral sling is attached to the needles and positioned beneath the mid urethra without tension. Particular attention is paid to appropriate sling placement, avoidance of excessive tension, and preservation of the surrounding anatomical structures. After confirming satisfactory positioning of the tape, the excess mesh is trimmed, and the vaginal and skin incisions are closed. The video highlights the key anatomical landmarks and essential technical steps of the TOT procedure, with emphasis on safe trocar passage, accurate midurethral sling positioning, and tension-free placement. It provides a concise visual demonstration of a standardized surgical technique that may be useful for surgeons and trainees involved in the management of female stress urinary incontinence.

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